Survey: Markups at 35 times wholesale

The price of generic Plavix, a blood thinner used by stroke and heart patients, varies from $19.35 to as much as $175 per prescription among the state’s pharmacies.

Cara DeGette/Colorado Public News

The price of generic Plavix, a blood thinner used by stroke and heart patients, varies from $19.35 to as much as $175 per prescription among the state’s pharmacies.

A Colorado Public News survey of cash prescription prices across Colorado has found consumers may be overpaying, as some drug prices turned out to be 30 to 35 times wholesale cost.

The finding comes at a time when 22 percent of uninsured Coloradans are risking their health by skipping prescriptions because they cost too much, according to the 2011 Colorado Health Access Survey.

The survey of prices of the five top-grossing drugs at dozens of pharmacies around the state found some huge price differentials. For example, generic Plavix, a blood thinner used by stroke and heart patients, is being sold for 30 to 35 times wholesale cost at many of the state’s largest pharmacies.

In contrast, pharmacist and owner Polo Martinez at Alamosa Pharmacy said he buys one month’s supply of generic Plavix – or clopidogrel – for the wholesale price of $4.35. He sells it to cash customers for $19.35. The price for the same drug currently ranges from $150 to $175 at Safeway, Walgreens, Target, Albertsons and RiteAid. Walmart and King Soopers/City Market were in the middle, closer to $50.

“I think we’ve gone from the Ice Age to the greed age,” Martinez said. He rattled off other prices that baffle him, including a diet pill that jumped from $1.29 to $50 per prescription in cost to his pharmacy, and a drug used to treat gout that leaped from $6 to $300 a month. “It’s crazy. It’s outrageous. I don’t understand.”

Target officials did not respond to inquiries about why their generic Plavix prices were so high. At Safeway, prices “are based on local competition,” said spokesman Kristine Staaf. Walgreens has a $20 annual membership card that drops the price of generic Plavix to about $50 per month, said spokesman Robert Elfinger. He also said prices are affected by local competition and the higher cost of the convenience of Walgreens’ locations, hours and services. RiteAid spokesman Eric Harkreader said his company tries to be competitive and would evaluate its price on generic Plavix.

Colorado Public News found that consumers could cut their cost of medications substantially by shopping around. They can also save by asking for price matches, finding coupons online, and asking their doctors for less expensive prescriptions. In addition, many widely used prescription medications are coming off patents, and large numbers of patients have not yet started saving hundreds of dollars a month by switching to generic versions.

Many people pay the cash price for prescriptions, if they are uninsured or their insurance doesn’t cover drugs. Insurance companies negotiate varying prescription prices for their clients, which they refuse to reveal. But even the insured can cut their costs with these strategies.

There is a problem with price shopping, however. “There are dangerous pharmaceutical drug interactions between some medications, so a person should go to the same pharmacy, so the pharmacist can be aware of possible drug interactions,” said Val Kalnins, executive director of the Colorado Pharmacists Society.

Colorado Public News embarked on the survey after originally finding that prices for the top-selling anti-cholesterol drug did not drop as expected when the drug went generic. As detailed in a July news story, the prices for generic Lipitor varied by more than $100 a month at different pharmacies around the state.

In expanding the survey, CPN found the widest price variation in the other popular drug that had recently gone generic, Plavix. Prices for the other three top-selling drugs – all name-brand pharmaceuticals – differed by $41 to $113 per month. The three were Nexium for gastrointestinal acid reflux, Abilify, an antipsychotic used for major mental-health issues, and the asthma inhaler Advair.

Other key findings:

Some chains offer generics for $4 but that doesn’t include all generics. In fact, some of their other prices can be very high. Consumers need to check the price of each prescription at multiple locations.

Pharmacy size and location isn’t important. Members-only big-box Costco had the lowest price in the state for generic Plavix, at $13.87 online or in stores. But the next best were at independent pharmacies: Alamosa Pharmacy at $19.35 and Hays Drug in Paonia came in at just under $30.

Coupons: Patients can find a surprising number of coupons for prescriptions online. One cut the price of generic Plavix at King Soopers and City Market from $57-$71 to $15.56.

Consumers can request price matching: Costco’s low price was readily findable on the Internet, and can be tried at stores like Safeway, King Soopers/City Market, Walmart and Target that promise to price match stores in their areas.

Most pricing is secret: The major chains with the highest prices don’t list them online – at least not anymore. Costco, with consistently low prices, does. The company’s senior vice president for pharmacy Vic Curtis said that used to be normal, and Costco publishes because that’s how it draws customers to locations less convenient than the corner drugstore. The basic membership fee to shop at Costco is $55 per year. “The focus of the company is to have the best value on whatever we sell,” he said.

The website GoodRx.com collects what few published prices it can find, including coupon prices. It claims it can best even some insurance policy prices.

Ordering online from unknown sites can be risky: Fake online pharmacies may sell counterfeit drugs, which can damage health. “Canadian” pharmacies may not send drugs from Canada, but from places with iffy quality. The National Association of Boards of Pharmacy says it found only 3 percent of 10,000 online pharmacy websites compliant with the law.

Doctors and pharmacists will help if you ask: Physicians often can prescribe a less expensive medication. Physicians and pharmacists also know about special offers, including the Prescription Assistance program www.pparx.org and the Medication Assistance Program at nwww.rxassist.org, said University of Colorado pharmacy professor Sarah L. Anderson. The program is only for people with low incomes and stops after two years, when “the person is left to pay for them on their own.”

Anderson also says the pharmacy school, and many pharmacists, offer a “brown bag review,” where patients bring all of their prescriptions in for review – often in a brown paper bag. They dump out all of their pill bottles and the drugs are sorted through.

“Pharmacists and pharmacy students will check all of the prescriptions the patients are taking,” Anderson said. “They make sure the patients are taking prescriptions correctly, paying the right prices.”

Brent Ratliff and Sarah Wolberg contributed to this report. Colorado Public News, a nonprofit news organization, reports on issues of statewide interest. It partners with Colorado Public Television 12, Denver’s independent PBS station.

Price match, discounts

Chain stores in Colorado that offer price matching and discounts:

King Soopers/City Market: Price match, discounts and $4 for some generics.